Did you know, April is Irritable Bowel Syndrome (IBS) Awareness Month?
At Ignite, I primarily practice in functional gut disorders and other gut diseases. IBS is very near and dear to my heart – as someone who has suffered from IBS and has seen the impact nutrition and a holistic approach to IBS management can make, I’m a huge advocate that everyone with IBS should be involved with a dietitian.
Interestingly enough, many of my clients come to me ‘kinda/sorta’ diagnosed with IBS – they aren’t very confident in their diagnosis, or what it means. They’ve had all other gut conditions ruled out, and often they’re left with a ‘well I guess you have IBS’ diagnosis, and occasionally advice to eat more fibre.
There appears to be a lack of confidence in the medical community as to how to best manage these patients¹. It’s no wonder – I really believe that those with IBS require individualized nutrition advice to manage their symptoms. Each patient is different and does best when receiving practical nutrition advice from a dietitian trained in gut health and IBS management.
Where I find the BIGGEST knowledge gaps for IBS are:
- What constitutes an IBS diagnosis
- Stigma around an IBS diagnosis
- Why is IBS under-treated?
- What treatment options exist for those with IBS
How do they diagnose IBS?
IBS used to be a diagnosis of exclusion – meaning other conditions, like celiac, gastrointestinal viruses/bugs, and inflammatory bowel disease are ruled out or not suspected. Now, we’ve moved towards ruling these out, if suspected, followed by confirmation of diagnostic criteria.
I think people struggle so much with their diagnosis because there isn’t a specific test that says ‘yes! That’s it! This is exactly what you have’ – but rather is based on symptomatology.
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IBS diagnostic criteria is defined as recurrent abdominal pain or discomfort for at least 3 days per month for the last 3 months, with at least TWO of the following:
- Improvement of symptoms with defecation
- Onset associated with a change in the frequency of stool
- Onset associated with a change in the form/appearance of stool
The diagnostic criteria must be fulfilled for the last 3 months, with symptom onset at least 6 months prior to diagnosis².
To put it in lay-man’s terms – if you have abdominal pain or discomfort 3 days per month, for 3 months in a row, along side at least 2 of the 3 of the criteria (improvement in symptoms with defecation, pain/discomfort is associated with a change in the number of bowel movements, or the consistency of those bowel movements) – then there could be cause for an IBS diagnosis.
Practical Take-aways on IBS diagnosis:
- Suffering from abdominal pain and changes in bowel habits? See your family doctor.
- Don’t be afraid to talk about poop! Tell your doctor how often your having pain, how regularly you’re going to the bathroom, and what the consistency of your stool is. Don’t forget to mention if you’re experiencing bloating, distention (my clients often describe it as ‘5 months pregnant’ belly) or urgency.
- If you have blood, mucous, or clay coloured stools, be sure to tell your family physician as it may be cause for other tests.
- The only person qualified to diagnose IBS is your physician. Before you get started on any treatment plan, having a diagnosis is key.
As with any poorly understood condition – IBS seems to have developed a stigma. I’ve heard story after story of those with IBS being told ‘it’s all in your head’, or ‘if you just did (insert small intervention here) your symptoms would be fine’. It breaks my heart, and has a huge impact on how those with IBS feel about their disease – that it needs to be kept a secret, that it is somehow less valid, and that people don’t take their symptoms seriously.
At this point – we have a good understanding that IBS is complex. It involves how our brain and gut talk to one another, that the bacteria in our gut play a role, and that there are interventions to help manage symptoms – IBS isn’t just something you have to learn to live with.
Understanding that there are treatment options, that we’re still learning about how best to manage IBS, and that IBS is a very real disease can help to end the stigma around those with IBS.
Did you know, Canada has one of the highest rates of IBS in the world? 13-20% of the population suffer from IBS, with time to diagnosis being over 6 years. By ending stigma, more people can find solutions and manage their symptoms sooner.
[bctt tweet=”April is #IBSAwarenessMonth – IBS isn’t just something you have to learn to live with.” username=”andreahardyrd”]
Practical Take-aways on stigma around IBS
- Everyone’s experience with IBS is different – respect their story
- We don’t KNOW everything about IBS – far from it! We’re only now starting to understand how the brain and the gut communicate, how the gut microbiome plays a role, and how to best manage symptoms
- IBS isn’t just impacted by psychological conditions – rather we see links in epigenetics, how the gut bacteria talk to the brain rather than just how to the brain talks to the gut, history of illness, stress, and so much more.
Why is IBS Under-Treated?
Well – this one is complicated. So much of what we’ve learned about IBS has only just occurred in the past 10 years. We’ve only just begun to understand how the gut microbiome, carbohydrate malabsorption, and visceral hypersensitivity (how we perceive digestive sensations) contribute to IBS symptoms. In research terms – our understanding of IBS is still relatively new!
As such, awareness about the different treatment options are not always well-known.
As a dietitian that specializes in gut health – I am often the one spending the most time with you. Where I think we have huge gaps is our ability to rely on a ‘team approach’. At Ignite, I find it’s very important to bring other health professionals to the table – whether it’s your family physician, naturopath, psychologist, or other health professionals. A team approach is what’s needed in regards to IBS management – to ensure all those with an IBS diagnosis get appropriate treatment.
Practical Take-Aways on Under-Treatment of IBS
- Awareness and understanding of the treatment options is the biggest gap! Working with and relying upon experts to guide care, like dietitians specialized in IBS can help to coordinate treatment plans
Treatment Options for IBS that Are Evidence Based
As a dietitian, providing nutrition counselling that is rooted in evidence is so important. I always take a ‘food-first’ approach to managing my patients care, working with them on symptom management, practical implementation of nutrition recommendations, and most importantly making sure there is no risk of harm.
Managing IBS often takes a combination of approaches
At the Ignite offices, each clients’ nutrition intervention is based on their symptoms. My practice is grounded with 4 pillars for gut health.
- The Low FODMAP Diet – The low FODMAP diet involves removing carbohydrates that are known to be more difficult to digest, or malabsorbed, in IBS patients. I always explain to my clients – the low FODMAP diet is like a ‘bandaid’ solution. It helps to manage your symptoms, and determine which foods may cause triggers. However, it’s not safe to stay on the low FODMAP diet long term, as many FODMAP’s are important for gut health, and feed good bacteria. We eliminate FODMAP’s, determine triggers, and focus on improving gut health while including a balance of these foods to your upper most tolerable level
- Stress management and mindfulness – Mindfulness is the corner-stone of shifting the conversation between your brain and your gut, and how you perceive IBS symptoms. Working to manage stress and anxiety through mindfulness plays a role in how we perceive our gut symptoms, may positively influence our gut microbiome, and will help to gain awareness and understanding of situations that may exacerbate our IBS symptoms.
- Functional Foods – As a ‘food first dietitian’, I really see the value in using food to manage symptoms. When it comes to IBS, one of my go-to’s is peppermint. Peppermint has anti-microbial and anti-inflammatory actions, and influences how the gut contracts. The trouble with straight up peppermint (tea, etc) is that dosing can be different, and that muscle relaxing effects acting in the stomach can also trigger reflux.
A product we often use in practice is www.IBGard.ca. IBGard is a Natural Health Product in Canada they’ve taken peppermint oil, and put it into a pill form that allows peppermint oil to reach the small intestine. By delivering the peppermint oil to the small bowel, instead of the stomach is that my clients are less likely to get reflux with this form of delivery. I use this in two different ways in my practice, depending on the client. Firstly, IBGard is great for those ‘IBS flare ups’ – when you have symptoms you didn’t expect. Research shows that within 2 hours of taking IBGard, over 75% of those with IBS symptoms saw relief.
The second way I use www.IBGard.ca is before each meal to manage symptoms. Again, evidence supports the use of encapsulated peppermint oil to reduce IBS symptoms long term, by as much as 40%, without any other nutrition changes. I always suggest formulating a plan with your dietitian or physician in regards to the best way to take IBGard3,4
- A focus on gut health – 3 words. Fibre, fibre, fibre. Adequate fibre, and reduction of added sugars is paramount for gut health. While my clients implement the low FODMAP diet, we also focus on adequate fibre. My meal plans and practical nutrition advice around fibre make implementing this tip common sense, not confusing.
Let’s spread the word about IBS Awareness – share this article on Facebook & Twitter!
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Disclosure: This is a sponsored post. I was compensated for my time in writing this post to share about IBS Awareness Month. While the information conveyed may support clients’ objectives, the opinions expressed are my own and based on current scientific evidence. I do not engage in business with companies whose products or services do not match my personal and professional beliefs.
1.George F Longstreth, Raoul J Burchette; Family practitioners’ attitudes and knowledge about irritable bowel syndrome: Effect of a trial of physician education. Fam Pract 2003; 20 (6): 670-674. doi: 10.1093/fampra/cmg608
2. Rome Foundation. Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders. Retrieved from: http://romecriteria.org/assets/pdf/19_RomeIII_apA_885-898.pdf; 29 Mar 2017
3. Cash, Brooks D. et al. Su1373 Ibgard®, a Novel Small Intestine Targeted Delivery System of Peppermint Oil, Results in Significant Improvement in Severe and Unbearable IBS Symptom Intensity. Results From a US Based, 4-Week, Randomized, Placebo-Controlled, Multi-Center Ibsrest™ Trial. Gastroenterology , Volume 148 , Issue 4 , S-489.
4. Rouzbeh Shams, et al. Peppermint Oil: Clinical Uses in the Treatment of Gastrointestinal Diseases. JSM Gastroen. 2015 Retrieved from: https://www.jscimedcentral.com/Gastroenterology/gastroenterology-3-1036.pdf; 29 Mar 2017